Braced for Back Pain
Developments in Back Supports

Using orthoses (or braces) to manage spinal disorders presents many options and challenges to doctors, orthotists (people skilled in applying orthoses), and other rehabilitation professionals. Orthoses are available in various designs and for various uses. Working together, medical professionals can select the most appropriate device to treat your specific needs.

The use of spinal orthoses dates back to at least the Middle Ages. Originally, metal and leather were used to make the orthoses. Today, orthoses are made of materials ranging from cotton to the new generation of lightweight, durable thermoplastics. These modern fabrication materials have spawned new designs and have introduced a new level of comfort and an improved willingness among people to wear the orthosis as prescribed.

Why are orthoses used?

Spinal bracing encompasses three primary objectives. First, bracing can help control back pain. The brace can limit back motion and take the load off intervertebral discs (shock absorbers between back bones), vertebrae (back bones), and other spinal structures (e.g., muscles, soft tissues, and nerves). Second, bracing can temporarily stabilize and protect weak or injured spinal structures. It is often used for this purpose following disc surgery. Third, bracing can provide long-term protection, control, or correction of a spinal deformity. For example, bracing can help limit the natural progression of scoliosis (side-to-side curve of the spine) in adolescents.

Virtually all spinal orthoses achieve these objectives by three effects: 1) compressing the abdomen (stomach area), 2) restricting trunk motion, and 3) modifying skeletal alignment. An orthosis that is custom made to fit your body offers better control of motion than a "quick-fit," off-the-shelf spinal orthosis.

What types of orthoses are available?

Spinal orthoses are broadly categorized as either flexible or rigid. The flexible orthoses consist primarily of cloth belts and corsets. Rigid orthoses consist of plastic body jackets. With the recent innovations in resilient plastics, a new category of orthoses - semi-rigid - has been developed. Semi-rigid orthoses combine much of the strength and support of traditional rigid materials with the comfort of fabrics.

How are orthoses used?

Doctors prescribe flexible belts and corsets to help relieve low back pain associated with trauma, degenerative disc disorder (formation of bone spurs that irritate nerve roots), or postural fatigue (weak muscles that cannot help support the back). At times, doctors prescribe orthoses to provide some stability for the spine. They typically are made of cotton, nylon, or rayon fabric (see photo).

Rigid orthoses are used to immobilize the spine. An example of a rigid brace is the custom-molded body jacket, which is constructed of high-temperature thermoplastic. The orthosis often is used to treat people who have scoliosis or who have had surgery to fuse portions of the spine. It applies firm forces in all directions to prevent spinal motion, and it puts pressure on the abdomen. By applying pressure, the brace immobilizes the spine and takes stress off it. Because a properly molded jacket achieves total contact with the torso, pressures and forces are distributed over the widest possible area, increasing comfort and the likelihood that you will wear the orthosis as prescribed.

Finding the appropriate orthosis to treat an older person's spinal deformity presents a particular challenge to doctors and orthotists. Frequently, the spinal deformity is so severe that it needs the maximal correction that a rigid, molded-plastic body jacket can provide. However, older people commonly have problems such as reduced muscle tone, skin conditions, and scar tissue that can make wearing a rigid jacket intolerable. For these people, the soft body jacket is an alternative to the rigid body jacket. Like the hard jacket, it is custom molded to fit the person's torso, and it provides the total body contact. The soft version is constructed of lightweight plastic and very soft inner foam, making the jacket substantially more comfortable and easier to tolerate for extended periods than the hard jacket. However, the soft jacket is bulkier than the rigid jacket, and it does not give as much support as the rigid jacket gives.

Participation in an exercise program must accompany long-term brace wear. Exercise helps to maintain spinal motion and the strength of surrounding muscles. It also prevents you from becoming dependent on the brace after your back condition is gone.

William Anderson, C.O.
Columbus, Georgia